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Finals > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

what is septic shock

A
  • arterial blood pressure drops despite adequate fluid resuscitation, resulting in organ hypoperfusion.
  • Anaerobic respiration begins, and lactate level rises.
    It is diagnosed with:
  • Low mean arterial pressure (below 65 mmHg) despite fluid resuscitation (requiring vasopressors)
  • Raised serum lactate (above 2 mmol/L)
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2
Q

Mx of septic shock

A
  • aggressive IV fluids
  • HDU
  • vasopressors e.g. noradrenaline (cause vasoconstriction)
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3
Q

Rf for sepsis

A
  • immune dysfunction
  • frailty and very young
  • chronic conditions (COPD, diabetes)
  • chemo, immunosuppressants
  • surgery, trauma, burns
  • pregnancy
  • catheter, central lines
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4
Q

Bloods for sepsis

A
  • FBC for WCC + neutrophils
  • U&Es for kidney function + AKI
  • LFTs for liver function and a possible source of infection
  • CRP for inflammation
  • Blood glucose for hyper/hypoglycaemia
  • Clotting to assess for disseminated intravascular coagulopathy (DIC)
  • Blood cultures to assess for bacteraemia
  • Blood gas for lactate, pH and glucose
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5
Q

additional test for sepsis to locate source

A
  • urine dipstick
  • chest XR
  • CT abdo
  • LP
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6
Q

what is neutropenic sepsis

A

absolute neutrophil count below 0.5 x 109/L (or likely to fall to this level). It is a life-threatening medical emergency

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7
Q

Mx of neutropenic sepsis

A

immediate broad-spectrum antibiotics, such as piperacillin with tazobactam (tazocin)

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8
Q

Pyelonephritis sx

A

LUTI sx + triad
- loin to groin/back pain
- fever
- N&V
(renal angle tenderness)

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9
Q

when is MSU important in UTI

A
  • pregnancy
  • recurrent UTI
  • atypical sx
  • sx not improving on abx
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10
Q

Mx of LUTI

A
  • Nitrofurantoin (avoided in patients with an eGFR <45)
  • Trimethoprim (often associated with high rates of bacterial resistance)

can also go amoxicillin, cefalexin

3 days simple, 7 if man/pregnant, 5-10 days kidneys/immunosuppressed

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11
Q

Mx of pyelonephritis

A

first-line abx 7-10 days when treating in the community:
- Cefalexin
- Co-amoxiclav (if culture results are available)
- Trimethoprim (if culture results are available)
- Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)

SEPSIS 6 if in hospital

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12
Q

what to consider if pyelonephritis not improving

A
  • renal abscess
  • kidney stone
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13
Q

Mx of UTI in pregnancy

A

7 days + MSU
- Nitrofurantoin (avoided in the third trimester due to neonatal haemolysis)
- Cefalexin
- Amoxicillin (only after sensitivities are known)

avoid trimeth in 1st as folate antagonist (neural tube)

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14
Q

causes of cellulitis

A
  • Staphylococcus aureus
  • Group A streptococcus (mainly streptococcus pyogenes)
  • Group C streptococcus (mainly streptococcus dysgalactiae)
  • consider MRSA
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15
Q

Mx of cellulitis

A
  • flucloxacillin 1st line
  • clarithromycin
  • clindamycin
  • co-amoxiclav if near eyes/nose
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16
Q

common bacterial causes of intra-abdominal infections

A
  • Anaerobes (e.g. Bacteroides and Clostridium)
  • E. coli (gram-negative)
  • Klebsiella (gram-negative)
  • Enterococcus (gram +ve)
  • Streptococcus (gram +ve)
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17
Q

Mx of intra-andominal infections

A

need broad spectrum e.g.
- co-amoxiclav
- quinolones
- metronidazole
- gentamicin
- vancomycin
- cephalosporins
- tazocin

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18
Q

Mx of septic arthritis

A
  • joint aspiration
  • empirical IV abx for 4-6 wks
    e.g. fluclox, clinda, vanc, ceftriaxone (gonorrhoea)
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19
Q

Mx for influenza in people at risk

A
  • Oral oseltamivir (BD for 5 days)
  • Inhaled zanamivir (BD for 5 days)
    start within 48hrs of sx onset
20
Q

causes of viral gastroenteritis

A
  • rotavirus
  • norovirus
  • adenovirus
  • E coli 0157 (bloody)
  • campylobacter jejuni (MC worldwide, raw poultry)
21
Q

Shigella

A
  • spread by faeces or contaminated water/food
  • incubation 1-2 days
  • Mx: azithromycin
22
Q

Salmonella

A
  • raw eggs, poultry
  • incubation 12hrs-3days
  • sx resolve within 1 week
23
Q

Bacillus cereus

A
  • gram +ve rod
  • reheated rice
  • watery dirahhoea
24
Q

how to diagnose C.diff

A

Stools can be tested for:
- C. difficile antigen (specifically glutamate dehydrogenase)
- A and B toxins (by PCR or enzyme immunoassay)

25
Q

Mx of c.diff

A
  • oral vancomycin (1st)
  • oral fidaxomicin (2nd)

if serious oral van and IV metronidazole?
If recurrence <12 weeks oral fidaxomicin if >12 weeks van

26
Q

complications of c.diff

A
  • pseudomembranous colitis: inflam of large intestine with yellow/white plaques that form pseudomembranes on the inner surface of the bowel wall
  • toxic megacolon
27
Q

causes of meningitis

A
  • Neisseria meningitidis
  • Strep pneumoniae (pneumococcus)
  • Haemophilus influenzae
  • Group B streptococcus (GBS) (particularly in neonates)
  • Listeria monocytogenes (particularly in neonates)
28
Q

what is meningococcal septicaemia

A

non-blanching rash

29
Q

tests for meningeal infection

A
  • kernig’s test
  • Brudzinski’s test
30
Q

LP in bacterial and viral meningitis

A

Bacterial: cloudy, high protein, low glucose, high neutrophils
Viral: clear, mildly raised/normal protein, normal glucose, high lymphocytes

31
Q

complication of meningitis

A
  • hearing loss
  • seizures and epilepsy
  • cognitive impairment
32
Q

staining for TB

A

Zeihl-Neelsen stain, which turns them bright red against a blue background.

33
Q

Ix for TB

A
  • Mantoux test
  • Interferon‑gamma release assay (IGRA)
  • 3 sputum cultures
34
Q

Mx of TB

A

Rifampicin 6 months
Isoniazid 6 months
Pyrazinamide 2 months
Ethambutol 2 months

35
Q

side effects of TB treatment

A
  • Rifampicin: red/orange secretions
  • Isoniazid: peripheral neuropathy (prescribe pyridoxine (vit b6) to reduce risk)
  • Pyrazinamide: hyperuricaemia resulting in gout and kidney stones
  • Ethambutol: colour blindness, reduced visual acuity

RIP all assoc with hepatotoxicity

36
Q

examples of AIDS defining illnesses

A

when CD4 is low
- Kaposi’s sarcoma
- Pneumocystis jirovecii pneumonia (PCP)
- Cytomegalovirus infection
- Candidiasis (oesophageal or bronchial)
- Lymphomas
- Tuberculosis

37
Q

classes of antiretroviral therapy for HIV

A
  • Protease inhibitors (PI)
  • Integrase inhibitors (II)
  • Nucleoside reverse transcriptase inhibitors (NRTI)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTI)
  • Entry inhibitors (EI)

usually 2NRTIs + third agent

38
Q

additional mx of HIV

A
  • prophylactic co-trimoxazole when CD4 <200 to protect against PCP
39
Q

presentation of malaria

A
  • cyclic fever up to 41, sweats and rigors
  • myalgia
  • N/V, fatigue, headache
  • hepatosplenomegaly
  • jaundice
  • pallor
40
Q

how to diagnose malaria

A

blood film

41
Q

mx of malaria

A
  • Artemether with lumefantrine (Riamet) is the usual first choice
  • Quinine plus doxycycline
  • Quinine plus clindamycin
  • Proguanil with atovaquone (Malarone)
  • Chloroquine
  • Primaquine (can cause severe haemolysis in patients with G6PD deficiency)
  • severe: artesunate
42
Q

cryptosporidium parvum features

A
  • protozoan parasite
  • cause diarrhoea in immunocompromised patients
  • found in contaminated water sources
  • test: modified Ziehl–Neelsen stain/ Kinyoun Acid Fast stain
43
Q

Abx for MRSA +ve cellulitis

A

vancomycin

44
Q

late stage HIV presentation

A
  • folliculitis on chest
  • also fauces are red and there are two small aphthous ulcers on his left buccal mucosa. He also has a maculopapular erythematous rash on his upper trunk, red hands
45
Q

gram +ve bacteria

A
  • pair: strep pneumoniae
  • clusters: staph aureus

Finals (25 decks)

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